Oromandibular reconstruction with free fibula osteocutaneous flap after oncologic resection: retrospective analysis of surgical experience and operative outcome of 56 cases
DOI:
https://doi.org/10.18203/2349-2902.isj20194423Keywords:
Oromandibular, Fibula osteocutaneous flap, Free flap, OncologicAbstract
Background: Reconstruction of post oncologic resection oromandibular defect is challenging and it provides the base for subsequent radiotherapy and oromaxillary rehabilitation for functional and aesthetic outcome. Multiple reconstructive options including different free flaps exist in the present time of greater awareness, facility and expertise in the field of free tissue transfer surgery. But free fibula osteocutaneous flap (FFOCF) has been the state of art in this area. FFOCF is technically difficult but believed to be reliable even to start with and has a progressively comprehensive surgical technique and learning curve. We are presenting here our experience of FFOCF reconstruction of 56 cases over the last 3 years.
Methods: 56 patients operated between 2015 to 2018 were assessed retrospectively for operative and surgical outcome.
Results: Flap was successful in 54 (96.43%) cases. Re-exploration was done in 4 cases and was successful in 2 cases. Jaw shape and contour was satisfactory in 70.37% and solid food tolerance was noted in 80.35% cases. Recurrence was seen in 5 cases.
Conclusions: FFOCF is a reliable reconstructive option for complex oromandibular defect with a predictable outcome. Flap harvest is reliable and contouring is comprehensive. It gives good functional and aesthetic results with high success rate. Thus this flap is truly the preferred reconstructive option for all type of oncologic oromandibular defect with micro vascular surgery facilities.
References
Kumar PB, Venkatesh V, Kumar JKA, Yadav BY, Mohan SR. Mandibular reconstruction: overview. J Maxillofac Oral Surg. 2016;15(4):425-41.
Pai D, Wodeyar A. Evolution of mandibular defects reconstruction procedures: from older principles to newer techniques and technology. Acta Scientific Dent Sci. 2019;3(5):08-18.
Tideman H. Fibula free flap: a new method of mandible reconstruction. Int J Oral Maxillofac Surg. 1990;19(1):61.
Wu JCH, Lee YC, Cheng YC, Wu CW. Reconstruction of through-and-through oromandibular defect: comparison of four different techniques. Plast Reconstr Surg Glob Open. 2017;5(2):e1212.
Lee JT, Hsu H, Wang CH, Cheng LF, Sun TB, Huang CC. Reconstruction of extensive composite oromandibular defects with simultaneous free anterolateral thigh fasciocutaneous and fibular osteocutaneous flaps. J Reconstr Microsurg. 2010;26(3):145-51.
Kokosis G, Schmitz R, Powers DB, Erdmann D. Mandibular reconstruction using the free vascularized fibula graft: an overview of different modifications. Arch Plastic Surg. 2016;43(1):3-9.
Shpitzer T, Neligan PC, Gullane PJ, Freeman JE, Boyd BJ, Rotstein LE, et al. oromandibular reconstruction with the fibular free flap: analysis of 50 consecutive flaps. Arch Otolaryngol-Head Neck Surg. 1997;123(9):939-44.
Lopez-Arcas JM, Arias J, Del Castillo JL, Burgueno M, Navarro I, Moran MJ, et al. the fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg. 2010;68(10);2377-84.
Hidalgo DA, Rekow A. A review of 60 consecutive fibula free flap mandible reconstructions. Plastic Reconstructive Surg. 1995;96(3):585-96.
Hoffman G, Islam S, Eisenberg R. Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction - free fibula flap. Austral Dent J. 2012;57(3):379-87.
Peled M, El-Naaj IA, Lipin Y, Ardekian L. The use of free fibular flap for functional mandibular reconstruction. J Oral Maxillofac Surg. 2005;63(2):220-4.
Jones NF, Monstrey S, Gambier BA. Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation. Plastic and Reconstructive Surg. 1996;97(4):707-16.
Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plastic Reconstructive Surg. 1999;104(5):1314-20.
Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: The history, operative options and strategies, and our experience. ISRN Surg. 2011:82425.
Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, et al. Oromandibular reconstruction using microvascular composite flaps. Arch Otolaryngol- Head Neck Surg. 1998;124(1):46.
Reychler H, Ortabe JI. Mandibular reconstruction with the free fibula osteocutaneous flap. Int J Oral Maxillofac Surg. 1994;23(4):209-13.
Su T, Fernandes R. Microvascular reconstruction of the mandible: an argument for the fibula osteocutaneous free flap. Revista Espanola de Cirugía Oral y Maxilofacial. 2014;36(1):1-8.
Nambi G, Ahmad Q, Yadav P, Shankhdhar V. Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: a prudent alternative to double flaps in resource-constrained centres. J Cancer Res Therapeutic. 2012;8(1):91.
Wolff KD, Ervens J, Herzog K, Hoffmeister B. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Cranio-Maxillofac Surg. 1996;24(6):330-8.
Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plastic Reconstruct Surg. 2002;110(2):438-49.
Urken ML, Buchbinder D, Weinberg H, Vickery C, Sheiner A, Parker R, et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient. Laryngoscope 1991;101(9):935-50.
Holzle F, Kesting MR, Holzle G, Watola A, Loeffelbein DJ, Ervens J, et al. Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps. Int J Oral Maxillofac Surg. 2007;36(9):802-6.
Hundepool AC, Dumans AG, Hofer SOP, Fokkens NJW, Rayat SS, van der Meij EH, et al. Rehabilitation after mandibular reconstruction with fibula free-flap: clinical outcome and quality of life assessment. Int J Oral Maxillofac Surg. 2008;37(11):1009-13.